Provider Demographics
NPI:1417156399
Name:PATHWAYS PHYSICAL THERAPY,LLC
Entity Type:Organization
Organization Name:PATHWAYS PHYSICAL THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ANETRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-440-9880
Mailing Address - Street 1:241 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5877
Mailing Address - Country:US
Mailing Address - Phone:203-440-9880
Mailing Address - Fax:203-440-9881
Practice Address - Street 1:241 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5877
Practice Address - Country:US
Practice Address - Phone:203-440-9880
Practice Address - Fax:203-440-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006419261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0400870OtherORTHONET PROVIDER IDENTIFIER
CT080006419CT05OtherANTHEM PROVIDER ID
CTC03722OtherMEDICARE PTAN
CT7285170OtherAETNA PROVIDER ID
CTXV0104OtherHEALTHNET PROVIDER ID